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So when a medic says that someone with PA "can use the stored B12 in their liver", as far as I know, we simply don't know whether this is true or not

Vitamin B12 and folate deficiency can cause a wide range of problems, including: extreme tiredness a lack of energy pins and needles (paraesthesia) a sore and red tongue mouth ulcers muscle weakness disturbed vision psychological problems, which may include depression and confusion problems with memory, understanding and judgement Some of these problems can also happen if you have a deficiency in vitamin B12 or folate but do not have anaemia

Therefore, checking for megaloblastic anemia in a blood test is not conclusive evidence of a B12 deficiency, as we have seen many times, it does not occur, or it occurs later but not in the early stages

Thats not a motivation problem

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If you need to titrate carefully from 0.5mg upward, 5mg/ml provides finer adjustment increments